Iron and Folic Acid During Pregnancy
Why are iron and folic acid supplements essential in pregnancy and how do you take them correctly?
18/08/2026
Folic Acid — Essential Before and From Day One
Folic acid (also known as folate or vitamin B9) is critical for the formation of the neural tube — the structure that develops into your baby's brain and spinal cord. Neural tube defects (NTDs), such as spina bifida and anencephaly, develop in the first 28 days after conception — often before a woman even knows she is pregnant.
Daily folic acid supplementation in the weeks before conception and throughout the first trimester reduces the risk of NTDs by approximately 70%. Rwanda Ministry of Health recommends 400 micrograms (0.4 mg) of folic acid daily for all women of reproductive age who may become pregnant, increasing to 5 mg daily during pregnancy as part of the combined iron-folic acid supplement provided at ANC visits.
Iron — Preventing Anaemia and Protecting Against Haemorrhage
During pregnancy, your blood volume increases by approximately 50% to support your growing baby. This dramatic increase in blood volume creates a greatly increased demand for iron — the mineral used to make haemoglobin, the protein in red blood cells that carries oxygen. Without sufficient iron, you cannot produce enough red blood cells to meet this demand, resulting in iron-deficiency anaemia.
Anaemia affects maternal health in two critical ways. First, it causes fatigue, reduced physical capacity, and reduced immune function throughout pregnancy. Second, and more dangerously, it reduces your body's ability to withstand blood loss during or after delivery — postpartum haemorrhage is the leading cause of maternal death in Rwanda, and severe anaemia dramatically increases the risk of dying from haemorrhage.
How to Take Your Iron and Folic Acid Supplements
Rwanda's national ANC package provides a combined iron-folic acid (IFA) tablet — a single tablet containing both nutrients. The recommended dose is one tablet daily throughout pregnancy and for three months after delivery. This standard combined tablet contains 60 mg of elemental iron and 0.4 mg (400 micrograms) of folic acid.
For best absorption, take your iron tablet on an empty stomach — ideally 30 minutes before a meal or between meals. However, if iron causes nausea or stomach discomfort, taking it with food significantly reduces side effects and is preferable to not taking it at all. Taking iron with a vitamin C-rich drink (orange juice, fresh lime juice) enhances absorption. Avoid taking iron with tea, coffee, or calcium-rich foods (milk, cheese), which reduce absorption.
Managing Side Effects
Iron supplements commonly cause side effects including constipation, dark stools (black or dark green faeces — this is normal and harmless), nausea, and stomach discomfort. These side effects deter many women from taking their supplements — but they are manageable.
For constipation: increase your intake of water, fruits, vegetables, and high-fibre foods like beans, lentils, and whole grains. For nausea: take your tablet with food rather than on an empty stomach. Dark stools are not a cause for concern — they are simply iron being excreted. If side effects are severe enough that you are unable to take your supplement at all, tell your provider at your next ANC visit. Alternative formulations or timing may be available.
Dietary Sources of Iron and Folate
Supplements should be taken alongside a diet rich in iron and folate-containing foods. Rich iron sources in the Rwandan diet include: beans and lentils (ubwatwa, ibiharage), dark leafy green vegetables (imboga — spinach, amaranth, cassava leaves), organ meats (liver), fish, eggs, and groundnuts. Animal-source iron (haem iron) is absorbed more efficiently than plant-source iron (non-haem iron) — if you eat animal foods, include them regularly.
Foods rich in folate include dark leafy green vegetables, beans, lentils, avocado, and eggs. Cooking these foods briefly (steaming or stir-frying rather than boiling for long periods) preserves more of the folate content.
Related Articles
ANC: More Than Just a Clinic Visit
Antenatal care is a comprehensive programme of health checks, tests, treatments, and education — not just a routine appointment. Here is what ANC actually delivers for you and your baby.
Read articles
When Should I Start ANC?
Rwanda MoH and WHO both recommend starting ANC before 12 weeks. Here is why early registration is critical and what to do if your pregnancy was discovered late.
Read articles
How Many ANC Contacts Should I Have?
Rwanda MoH recommends a minimum of four ANC contacts, while WHO recommends eight or more. Here's the schedule, what each contact delivers, and why none should be missed.
Read articles